Chest Pain

What causes chest pain?

Chest pain is one of the most common reasons people see a cardiologist, and one of the most important to evaluate properly. It can come from the heart itself, but it can also come from the lungs, the esophagus and stomach, or the muscles and joints of the chest wall.

Heart-related causes include reduced blood flow to the heart muscle (angina), a heart attack, inflammation of the sac around the heart, and problems with the heart valves or aorta. Non-cardiac causes include acid reflux, muscle strain, anxiety, and lung conditions such as pneumonia or a blood clot in the lung.

The purpose of a cardiac evaluation is to determine whether your heart is the source — and if it is not, to help point you toward the right kind of care.

What does cardiac chest pain feel like?

Chest pain from the heart is often described less as a sharp pain and more as a pressure, squeezing, heaviness, or tightness. It may spread to the arm, shoulder, neck, jaw, or back. It is often brought on by exertion or emotional stress and eases with rest.

Not everyone has typical symptoms. Women, older adults, and people with diabetes are more likely to have heart problems that show up as shortness of breath, unusual fatigue, nausea, or discomfort in the upper abdomen rather than classic chest pain.

When should chest pain be treated as an emergency?

Call 911 if chest pain is sudden or severe, lasts more than a few minutes, or comes with shortness of breath, sweating, nausea, lightheadedness, or fainting — or if it spreads to the arm, jaw, neck, or back. Emergency treatment for a heart attack works best when it happens quickly, and the ambulance can begin care on the way to the hospital.

Chest discomfort that is milder, comes and goes over weeks, or appears only with certain activities still deserves attention. That pattern should be evaluated promptly on a scheduled basis rather than ignored.

How do cardiologists evaluate chest pain?

Evaluation starts with a careful history and physical exam — what the pain feels like, what brings it on, what relieves it, and what other risk factors you have. From there, testing is chosen based on your individual situation and may include:

• Electrocardiogram (EKG) — records the heart's electrical activity and can show signs of reduced blood flow or prior injury
• Echocardiogram — an ultrasound that shows the heart's structure, pumping function, and valves
• Stress testing — looks at how the heart performs under exertion, either with exercise or with medication
• Ambulatory rhythm monitoring — a wearable monitor that records the heartbeat over days or weeks
• Cardiac catheterization — a catheter-based study that shows blockages directly, used when noninvasive testing suggests significant disease

How is chest pain treated?

Treatment depends entirely on the cause. Chest pain from coronary artery disease may be managed with medications and risk-factor treatment, and in some cases with a catheter-based procedure to open a narrowed artery. Chest pain from another source is treated by addressing that source. When the evaluation is reassuring, knowing that your heart is not the problem is itself a meaningful result.

This page is general health information, not medical advice. It cannot replace an evaluation by a physician who knows your history. Talk with your cardiologist or primary care physician about what applies to you.